DONOR SELECTION INFLUENCES THERAPEUTIC EFFECTS OF FECAL MICROBIOTA TRANSPLANTATION FOR ULCERATIVE COLITIS

Abstract Background We have recently reported the efficacy of combination of triple-antibiotic therapy and fecal microbiota transplantation (A-FMT) for patients with ulcerative colitis (UC). It has been reported that FMT with frozen donor faeces (frozen-FMT) is as effective as fresh-FMT for Clostridium difficile infection. However, it is still unclear which donor and condition is suitable for FMT on UC. The aim of this study was to evaluate the effectiveness of frozen-FMT compared to fresh-FMT, and verify effective conditions. Moreover, we explore the concept of best donor for A-FMT success. Methods This prospective and randomized controlled study was conducted from July 2017 to September 2019 at Juntendo University Hospital. Eligible patients were at least 20 years of age, with a diagnosis of active UC which were required a Lichtiger’s clinical activity index (CAI) of 5 or more, or with an endoscopic Mayo score of 1 or more. Patients were randomly allocated fresh or frozen faecesfrom 2 healthy donors. Triple-antibiotic therapy (Amoxicillin, Fosfomycin, Metronidazole; AFM) was administered to patients with UC for 2 weeks, and up to 2 days before FMT. Clinical outcomes were assessed at8 weeks and 1 year after treatment. Clinical response was defined as a decrease of CAI of 3 points or more, and remission was defined as 3 points or less. Maintenance of efficacy was defined as no exacerbation of CAI and no intensification of treatments. Results 29 patients completed protocol (fresh-FMT; n = 15, frozen-FMT; n = 14). At 8 weeks after treatment, clinical response and remission were observed in fresh-FMT (46.7%, 33.3%), and in frozen-AFM (64.3%, 42.9%) respectively.There were no significant differencesin therapeutic effectsbetween frozen-FMT and fresh-FMT.On the other hand, in cases which age difference between donor and patient was more than 16 years, maintenance rate was significantly lower than 0–15 age difference (0–15 vs ≧16, n = 14, 15 p<0.05). Interestingly,in cases that age difference between patient and donor was 0–15 years, high therapeutic effect was observed in patients treated withfresh- FMT. Conclusion This study showed that A-FMT with frozen faeces is as effective as cases treated with fresh faeces. In addition, findings from this study indicate that donor selection influences treatment effects, and age difference between patient and donor might be an important factor for A-FMT success.